Counselor Check-In Referral Form

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IF THIS IS A BEHAVIORAL HEALTH CRISIS - PLEASE CALL 911 OR THE GEORGIA CRISIS AND ACCESS LINE AT 988 OR THE LOCAL EMERGENCY ROOM.

This form can be used to make a referral for your student to check-in with a counselor at school.

Email *

Student First and Last Name *

Parent/Guardian First and Last Name *

Parent/Guardian Phone Number *

What school is the student attending? *

Banks County Primary School

Banks County Elementary School

Banks County Middle School

Banks County High School

What are the concerns that need to be addressed with the counselor? IF THIS IS A BEHAVIORAL HEALTH CRISIS - PLEASE CALL 911 OR THE GEORGIA CRISIS ACCESS LINE AT 988. *

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This form was created inside of Banks County Board of Education.